Individual
JEFFREY LANCE BACON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
615 FAIRHURST ST, STERLING, CO 80751-4564
(970) 521-3223
Mailing address
1010 N COUNTRY CLUB DR, MESA, AZ 85201-3309
(480) 461-2409
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
38444
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
95304789
—
CO
Enumeration date
03/24/2006
Last updated
03/18/2008
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